Evidence map›Paper›PMID 36441271›Full record

ArticleBreast cancer research and treatment2023

Textbook outcomes in DIEP flap breast reconstruction: a Delphi study to establish consensus.

Ronnie L Shammas, Geoffroy C Sisk, Christopher J Coroneos, Anaeze C Offodile, Rene D Largo, Arash Momeni, Nicholas L Berlin, Summer E Hanson, Adeyiza O Momoh, Jonas A Nelson and 3 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Breast cancer research and treatment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Ronnie L ShammasDivision of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.ORCID http://orcid.org/0000-0001-5468-8646
Geoffroy C SiskDivision of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.
Christopher J CoroneosDivision of Plastic Surgery, Department of Surgery, Hamilton, ON, Canada.
Anaeze C OffodileDepartment of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Rene D LargoDepartment of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Arash MomeniDivision of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Ca, USA.
Nicholas L BerlinDepartment of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
Summer E HansonDepartment of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Adeyiza O MomohDepartment of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
Jonas A NelsonDepartment of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Evan MatrosDepartment of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kristen RezakDivision of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.
Brett T PhillipsDivision of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA. brett.phillips@duke.edu.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Hongbiao Carl Lekaye · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

purposeComposite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and quality of care. This study utilized a Delphi process to define a textbook outcome in DIEP flap breast reconstruction.

methodsA two-round Delphi survey defined: (1) A textbook outcome, (2) Exclusion criteria for a study population, and (3) Respondent opinion regarding textbook outcomes. An a priori threshold of ≥ 70% agreement among respondents established consensus among the tested statements.

resultsOut of 85 invitees, 48 responded in the first round and 41 in the second. A textbook outcome was defined as one that meets the following within 90 days: (1) No intraoperative complications, (2) Operative duration ≤ 12 h for bilateral and ≤ 10 h for unilateral/stacked reconstruction, (3) No post-surgical complications requiring re-operation, (4) No surgical site infection requiring IV antibiotics, (5) No readmission, (6) No mortality, (7) No systemic complications, and (8) Length of stay < 5 days. Exclusion criteria for medical and surgical characteristics (e.g., BMI > 40, HgbA1c > 7) and case-volume cut-offs for providers (≥ 21) and institutions (≥ 44) were defined. Most agreed that textbook outcomes should be defined for complex plastic surgery procedures (75%) and utilized to gauge hospital performance for microsurgical breast reconstruction (77%).

conclusionThis Delphi study identified (1) Key elements of a textbook outcome for DIEP flap breast reconstruction, (2) Exclusion criteria for future studies, and (3) Characterized surgeon opinions regarding the utility of textbook outcomes in serving as quality metric for breast reconstruction care.

Indexed as

Breast NeoplasmsMammaplastyPerforator FlapDelphi TechniqueFemaleHumansMastectomyPostoperative ComplicationsRetrospective StudiesTreatment OutcomeBreast reconstructionComposite measuresDelphi studyTextbook outcomes

Identifiers

PMID36441271
PMCPMC9892240

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.